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Home My WebLink About08-16-12 (2) REV-1500 Ex (°'-'°> PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN Harrisbur , PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 1 8 8 1 2 3 5 1 7 0 5 2 3 2 0 1 2 Decedent's Last Name Suffix B I R D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number County Code Year File Number 2 1 1 2 0 6 6 9 Date of Birth MMDDYYYY D 8 0 3 1 9 2 0 Decedent's First Name MI R U T H ~ Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FIL REGISTER OF WILLS L IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Return ^ 3 Re i 4 Limited E . ma nder Return (date of death prior t 12 . state o ^ -13-82) 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Ret d OX 6. Decedent Died Testate urn Required eath after 12-12-82) ^ 7 D d (Attach Copy of Will) ^ 9 Liti ati P . ece ent Maintained a Livin Trust (Attach Copy of Trust) g 8• Total Number of Safe Deposit Boxes . g on roceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11 Electi . on to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFID N t S ame ENTIAL TAX INF ORMATION HOULD BE DIRECTED TO: M U R R E L W A Daytime Telephone Number L T E R S I I I E S Q 7 1 7 6 9 7 4 ,~6. 5 0 REGISTER®LLS USE ~ttl'LY _ ) First line of address ^.~ ~ ~ ,- , ` ~ _ 1 _f ~ ... t , 5 4 E M A I N ~~~?~ S T R E E T ~-'~ r Second line of address .~ :`~ : } C~cJ ' ~ City or Post Office -- i w ~ ri7 ~ ' : ~ ~ State ZIP Code DATE FILED ~ M E C H A N I C S B U R G P A 1 7 0 5 5 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct and complete. Declaration of preparer other than the personal representative is based on all i f , n ormation of which preparer has any knowledge. SIG ATU OF PERSON RESP NSIBkE FOR FILING RETURN ~ J ~ - DAT ADDRESS S ~~ a Q ~ ~ THELMA B. F S E 7 CHARLES ST. MECHANICSBURG SIGNATURE OF P RE T T P A 17 D 5 5 REPRE SENTATIVE ADDRESS DATE ~ l4 ~ 2-- MURREL R. W LTERS, III, 54 E. MAIN ST MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 L 1505610140 15056107,40 J a 150561D140 1505610240 REV-1500 EX Decedent's Name: RUTH \1 • B I R D RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2. Stocks and Bonds (Schedule B) ............... . ... . . .. .............. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. Decedent's Social Security Number 1 8 8 1 2 3 S ~. ~ D, D D 5 8 6 7 9. 2 0 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. 6. 7. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 1 5 1 6 1 4 , 7 1 8. 9. 10. 11. Total Gross Assets (total Lines 1 through 7) ................. ~~~~...... $. Funeral Expenses and Administrative Costs (Schedule H) .... . ............. 9. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ . 10. Total Deductions (total Lines 9 and 10 2 1 0 6 1 2 9 3, 9 8 6 3. 5 8 7 0. 5 1 0 4 12. 13. ) ............ . .. . . . ... . 11. Net Value of Estate (Line 8 minus Line 11) ............ . 12 Charitable and Governmental Bequests/Sec 9113 Tr t f 8 2 D 1 7 3 4. 0 5 5 9 , g 4 7 us s or which an election to tax has not been made (Schedule J) ................... . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . ... , ..... , TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.0 D D D 15 16. Amount of Line 14 taxable . at lineal rate X .0 17. Amount of Line 14 taxable ~ 16. at sibling rate X .12 2 0 1 5 5 9. 8 7 18. Amount of Line 14 taxable 17. at collateral rate X .15 D D D 18. 19. TAX DUE ......... ........................................... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 2 0 1 5 5 9. 8 7 D. D 0 0. D 0 2 4 1 8 7. 1 8 0. D 0 2 4 1 8 7. 1 8 1505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 12 0669 DECEDENT'S NAME RUTH V. BIRD STREETADDRESS 712 CHARLES STREET CITY MECHANICSBURG STATE PA Tax Payments and Credits: ~• Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B, Discount 1 209.35 3. Interest Total Credits (A + B ) ZIP 17055 (1) 24 187.18 (2) 1 209.35 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT 0.00 22 977.83 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; Yes No b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X c. retain a reversionary interest; or ................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X 2. If death occurred after December 12, 1982, did decedent transfer ro ert within ^ ^ without receivin ade uate consideration . p p y one year of death 9 4 ~ ....................................................................................... ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .....,.,, 4. Did decedent own an individual retirement account, annuity or other non-probate property, which ^ ^ contains a beneficiary designation? .................................................................................................. ^ X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND ^ FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)j. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. KEV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RUTH V. BI ITEM NUMBER SAVINGS BONDS SCHEDUL EB STOCKS & BONDS FILE NUMBER z1 12 All propertyjointlyowned with right of survivorship must be disclosed on Schedule F. 8 EE NET REDEMPTION VALUE (If more space is needed, insert additional sheets of the same size) DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 58,679.20 KtV-1508 EX+ (~ 1-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT CCTATC nr. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY TH V. BIRD FILE NUMBER: ITEM NUMBER 1. 2. 3. 4. 5 6. 7 8, CITIZENS BANK CHECKING CITIZENS BANK MONEY MARKET WELLS FARGO CHECKING WELLS FARGO SAVINGS CASH HIGHMARK MEDICAL INSURANCE REFUND PNC BANK CHECKING PNC BANK MONEY MARKET inaude the proceeds of litigation and the date the proceeds were received by the estate` unn. All property jointly owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION TOTAL (Also enter on Line 5 Recapitulation) I $ If more space is needed, insert additional sheets of paper of the same size VALUE AT DATE OF DEATH 5,643.53 42,252.18 500.04 48,309.65 300.00 167.20 2,150.39 52,291.72 151,61 rcty-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT DECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF RUTH V. BIRD FILE NUMBER 21 12 0669 Decedent's debts must be reported on Schedule I. ITEM NUMBER A DESCRIPTION • FUNERAL EXPENSES: AMOUNT ~• 2 AUER FUNERAL HOME, HARRISBURG, PA (PREPAID) • TOMBSTONE 3• 4 CEMETARY GRAVE OPENING-ST JOHNS CHURCH DANVILLE PA 2>000.00 • 5 , , FURNERAL LUNCHEON-ST JOHNS CHURCH, DANVILLE PA 100.00 • , ROOM RENTAL LUNCHEON-ST JOHNS CHURCH, DANVILLE, PA 125.00 50.00 B• ADMINISTRATIVE COSTS: ~ Personal Representative Commissions: Name(s) of Personal Representative(s) THELMA B. FISSEL Street Address 712 CHARLES STREET City MECHANICSBURG State PA ZIP 17066 Year(s) Commission Paid: RENOUNCED) 2. Attorney Fees: MURREL R. WALTERS, III 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 4,200.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 388.50 5 Accountant Fees: 6• Tax Return Preparer Fees: 7 TOTAL (Also enter on Line 9, Recapitulation) n more space is needed, use additional sheets of paper of the same size. rcty-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT r~r.~~ ,. RUTH V. FILE Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE 1• MESSIAH VILLAGE OF DEATH RESIDENTIAL CARE 1,617.65 2• ALERT PHARMACY MEDICAL 3• (PINNACLE HEALTH MEDICAL 52.89 200.00 TOTAL (Also enter on Line 10 Recapitulation) I $ If more space is needed insert additional sheets of the same size. 1 SCHEDULE( DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: RUTH V. BIRD FILE NUMBER: 21 12 0669 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under OF ESTATE Sec. 9116 (a) (1.2).j 1~ THELMA B. FISSEL 712 CHARLES STREET Sibling MECHANICSBURG, PA 17055 33.00 2. DAVID E. BIRD 68 WONDERVIEW ROAD Sibling CATAWISSA, PA 17820 33.00 3. JANE B. BRANDY 301 JADE AVENUE Sibling DANVILLE, PA 17821 33.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed, use additional sheets of paper of the same size.